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When doctors are accused of upcoding or unbundling

On Behalf of | Jun 7, 2018 | White Collar Crimes |

Doctors can have a lot of paperwork to deal with in connection to the care of their patients. This includes billing paperwork, such as billing related to Medicaid. Being accused of acting fraudulently in connection to such billing can create serious problems for a doctor. There are many different kinds of Medicaid fraud doctors could be accused of. Today we will go over two such types: upcoding and unbundling. Both involve billing codes.

What is upcoding?

Upcoding involves not using the right billing codes for a given situation. Specifically, it is when services are billed at a higher complexity level than what was actually provided.

What is unbundling?

There are certain situations in which a single global billing code covers a group of procedures. When this is the case, but a doctor doesn’t use this global code but instead bills for multiple other codes, this is unbundling.

Responding to allegations of these types of Medicaid fraud

These two types of behavior can result in higher Medicaid bills than should have been the case. So, upcoding and unbundling are very serious accusations for doctors to be facing. Being accused of such behavior could lead to Medicaid fraud charges being brought against a doctor. This could put his or her freedom, financial well-being, professional reputation and professional future at stake. So, how a doctor responds to such allegations, and any corresponding charges, can have significant impacts. Given this, doctors accused of upcoding or unbundling may want to promptly seek out a defense attorney’s guidance on how best to proceed.